Chinese Herbal Medicine Probed by State : Officials Concerned That Cinnabar Might Cause Mercury Poisoning

The sale of cinnabar--mercury ore--at herbal medicine stores is being investigated by state health officials worried that its use as a sedative in centuries-old Chinese medical treatments might cause mercury poisoning.

The investigation was touched off by reports that the fine red powder, which is made up primarily of mercuric sulfide, is sold at Chinese herb stores in San Francisco and San Jose. Cinnabar is also sold at Chinese herbal medicine shops in Los Angeles’ Chinatown, where a Times reporter found it readily available at four stores.

“We Chinese have used this medicine for more than 1,000 years, and there’s never been any trouble,” said a doctor of Chinese medicine who works at one of the Chinatown stores.

This man, who declined to be identified by name, said that cinnabar--known in Mandarin Chinese as zhu sha-- is generally used under the guidance of a doctor of Chinese medicine. “We tell them not to take too much,” he said.

Brain, Kidney Damage

Selling cinnabar as a medicine is illegal, according to the state Department of Health Services. Mercury poisoning can cause brain and kidney damage, but health officials said they do not know whether the amounts that may be ingested are sufficient to cause noticeable damage.

“We want to err on the side of conservatism in warning people that this may be harmful,” said Raymond Wilson, a pharmacology specialist with the department. The department began looking into the question in response to an investigation by the San Jose Mercury News.

The state’s ability to control the substance as a drug may be limited, however, because sellers questioned by investigators have denied selling cinnabar as a medicine, Wilson said. Cinnabar is sometimes used as part of a ritual treatment in which it is mixed with other herbs to make amulets that are tied to the patient’s wrist, he said.

“There is some representation it is being used in the community for medicinal purposes, but that’s not what the sellers are claiming,” Wilson said. “We are looking into the possibility of controlling it as a hazardous substance.”

Control Nervousness, Insomnia

Clerks or Chinese herbal specialists at the four shops in Los Angeles all said that cinnabar is sometimes taken internally to control nervousness, insomnia or other problems that are seen as related to the heart or emotions.

“Actually, in the old days, most people believed it chased the devil away,” explained an herbalist who said much of the cinnabar he sells is used with other herbs in amulets. He added, however, that sometimes patients come with prescriptions for internal use.

“They put a little of that on a pig’s heart, and they put it in a jar with a couple cups of water in there, and they steam it,” he said. “Then they drink the juice.” Shop clerks said most of the cinnabar is imported from China.

According to the Handbook of Chinese Herbs and Formulas, written by Him-che Yeung, a Los Angeles acupuncturist and herbalist, cinnabar functions as a sedative and tranquilizer, an anti-convulsive and a detoxicant. “Internally it is a sedative (and) externally it is anti-bacterial and anti-parasitic,” according to the book, which is kept on a handy shelf at two of the Chinatown stores.

‘Sweet, Cold, Toxic’

The book describes cinnabar’s properties as “sweet, cold, toxic,” and said the recommended dosage is 0.3 grams to 1 gram. Its use includes treatment of insomnia, heart palpitations, epilepsy and boils, the book says.

Yeung, the book’s author, who runs the Acu-Herb Clinic in West Los Angeles, said she doubts that there is any cause for worry about the use of cinnabar.

“The toxicity is very low, and usually we don’t tell the patients to take it a long time,” Yeung said. “It’s a sedative. Some people that have been on Valium, and they come to us, sometimes we’ll give them this formula. The effect is pretty good and they calm down right away.” Yeung said cinnabar is available in pills, mixed with other ingredients.

Yeung said she believes that increased scientific research into the properties of traditional Chinese medicines is a good idea. This could help prove the beneficial effects of many herbs, and thus lead to their wider use and also provide more knowledge about any possible toxic side effects, she said.

‘Used for Sedation’

David K. Osborn, a Pasadena herbalist, described cinnabar as “one of those heavy mineral elements used for the purpose of sedation.”

“I myself don’t use it, and I would hesitate to use it, primarily because of the mercury in it,” Osborn said. “But I’m not going to go on a crusade against it. I believe a lot of herbs and natural medicines are being blacklisted and persecuted by overzealous health authorities claiming that they are toxic or lethal. They may be potent, but they aren’t toxic, especially compared with a lot of our synthetic drugs with all their strong side effects.”

Wilson said that state health officials are checking published research in gathering information about the toxicity of cinnabar.

“The toxicity information on mercuric sulfide lists it as a highly toxic substance,” he said. Officials, however, have not located any studies measuring the effect on laboratory animals of specific amounts of the substance, he said.

Officials also do not know, he said, whether traditional Chinese preparation techniques lessen the risk. “We don’t know if the mercury stays on the bottom of the pot,” he said.

A Times reporter who purchased a small vial of cinnabar was told that it was enough for a single treatment, to be taken in two doses.

Laboratory analysis of the substance by Thermo Analytical-ARLI of Monrovia found that it contained 1.656 grams of impure cinnabar, with mercury content of 0.416 grams. Raymond Jay, a chemist with the firm, said that because the mercury was in the highly insoluble form of mercuric sulfide it would not be readily absorbed by the body. “It’s very likely that that’s not soluble enough to cause a lot of trouble,” he said.

100 Times Tolerable Level

Paul Papanek, chief of toxic epidemiology for the Los Angeles County Health Department, estimated that three or four milligrams of mercury would be absorbed into the bloodstream by someone who ingested one gram of cinnabar. That is about 100 times what is normally considered a tolerable level of mercury intake, but is probably not enough to cause symptoms of mercury poisoning, he said.

Five such one-gram doses over a two-week period, he said, might cause detectable symptoms such as mouth sores, finger tremors or depression. Mercury ingested by a pregnant woman can pass to the fetus and cause brain damage, he added. “I would certainly worry that there could be brain damage to a developing fetus,” he said.

Kidney damage from repeated intake of cinnabar could have a cumulative effect that by itself probably would not be serious, but that might increase the problems of a person suffering from other kidney troubles, Papanek said.